Provider Demographics
NPI:1164166377
Name:ELITE MENTAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ELITE MENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:WAMUYU
Authorized Official - Last Name:WAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-629-1828
Mailing Address - Street 1:6738 S TUCANA LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8784
Mailing Address - Country:US
Mailing Address - Phone:314-629-1828
Mailing Address - Fax:
Practice Address - Street 1:6738 S TUCANA LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-8784
Practice Address - Country:US
Practice Address - Phone:314-629-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251S00000XAgenciesCommunity/Behavioral Health